Cardiovascular mortality is the predominant cause of death in chronic hemodialysis patients. With the continuing expansion of a population at significant cardiac risk, due to an increasingly larger number of older patients with treated end stage renal disease (ESRD) and diabetic nephropathy, it becomes increasingly of ischemic heart disease in patients with ESRD.The with ESRD utilizing the United States Renal Data System. The first objective is to characterize the clinical determinants of morbidity and mortality of acute myocardial infarction in patients on chronic hemodialysis. Surprisingly, no published study has reported the mortality rate of acute myocardial infarction (MI) in a large population of chronic hemodialysis patients (nor examined therapeutic outcomes), and recent thrombolytic trials have excluded these patients. For this reason, the overall in-hospital mortality rate of acute MI in chronic hemodialysis patients will be estimated, with attention to examination of clinical determinants of outcome. A similar separate analysis will be performed for patients with renal transplants. The second objective of this study is to examine the clinical outcome of patients with ESRD, particularly patients on chronic hemodialysis, having coronary artery revascularization procedures. Previous published reports have focused on results of coronary revascularization in small groups of ESRD patients having percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass surgery (CABG). The morbidity and mortality of coronary artery revascularization procedures (PTCA or CABG) and clinical factors affecting outcome, will be analyzed in a large population of patients with ESRD using the United States Renal Data System Patients on chronic dialysis and those with renal transplants will be analyzed separately. The total number of patients who have been reported in the literature in reads to the two questions posed in this proposed study has been exceedingly small. The interpretation of previously published data is complicated by "single center bias"- the renting of small series may inaccurately reflect the true clinical experience of the ESRD population at large. Using the United States Renal Data System, a more accurate representation of the morbidity and mortality associated with AMI in patients with ESRD and the outcome of coronary artery revascularization procedures in this patient population should be attainable.